What is the "true benefit" of a beta-blocker?

[Buzz Lanning]

Background – My cardiologist wants me to continue taking Toprol for blood pressure control after AVR last summer. Why not prescribe an ACE inhibiter, or some other type of medication, that has fewer side effects (than a beta-blocker)? Yes, I know beta-blockers also reduce your heart rate, but mine was already low from being a runner / swimmer; i.e., my HR was 37 bpm during a recent Holter monitor test (while sleeping).

Anyway, I would like to take an ACE inhibitor only (and drop the Toprol), unless there’s a compelling reason to use beta-blockers for blood pressure control. Why do I care? - I feel beta-blockers are “possibly” affecting my performance while running & swimming; this side effect has been mentioned for this type of medication. Just a thought . . .

I guess the good news is; beta-blockers slow the heart rate, therefore, fewer cycles on the valve. Therefore, longer valve life!

THANKS!

[LLJ]

Hey Buzz, sorry I didn't see this one when I replied to your other one! I asked my cardiologist this same question when he said he wanted to keep me on Toprol "the rest of my life" You are right, he said athletes place more demand on the heart for short periods of time and the Toporol would lessen the load on the heart and increaase the longevity of the valve(theoretically). (i have a tissue valve%) He changed me to Toprol XL 25mg and it truely feels so much better than the regular metatoprol, I don't feel as funky,
Laura

[hensylee]

dr told me it's to slow heart and help w/bp. I did ask if I could drop one pil/day (I take two) and he said check my bp, call him in a week. The bp didn't go down any so I still take two.

[MitralMan]

I take Metoprolol 2x/day (25mg each time), and my bp when I wake up is typically 95/60. I too think I'll be on it for the rest of my life. It didn't prevent me from hitting 165 bpm a couple of days ago, but that's a good thing -- I think (it was in the context of running).

[901]

Background – My cardiologist wants me to continue taking Toprol for blood pressure control after AVR last summer. Why not prescribe an ACE inhibiter, or some other type of medication, that has fewer side effects (than a beta-blocker)? Yes, I know beta-blockers also reduce your heart rate, but mine was already low from being a runner / swimmer; i.e., my HR was 37 bpm during a recent Holter monitor test (while sleeping).

Anyway, I would like to take an ACE inhibitor only (and drop the Toprol), unless there’s a compelling reason to use beta-blockers for blood pressure control. Why do I care? - I feel beta-blockers are “possibly” affecting my performance while running & swimming; this side effect has been mentioned for this type of medication. Just a thought . . .

I guess the good news is; beta-blockers slow the heart rate, therefore, fewer cycles on the valve. Therefore, longer valve life!

THANKS!

I met with the St. Judes rep in our area earlier this week. We were talking about the valves and he told me that they have tested the valve to an equivalent number of cycles to what they would expect for 250 years of service. I don't think with that type of life span on the valve that a beta blocker will save enough cycles that you would be able to measure the difference between the valve life with and without the beta blocker.

Since my surgery, I have only been on an ACE inhibitor and rat poison. Prior to surgery, I was taking Coreg twice a day (for A-Fib) also.

[Phyllis]

Buzz, I didn't see this the first time you posted. Interesting because Dick just this week asked his cardio if he could go off Lopressor (also a beta blocker) and use just a blood pressure medication. He suggested we cut the lopressor in half and take his blood pressure for two weeks and then get back to him. He never explained that the beta blocker may prolong valve life- will have to question him on that one when we report back!

[MelissaM]

Buzz,

Doctors can give you their best guess of what is right for you, you hold the other half of the equation. Together (hopefully) you can make a decision that is right for you.

I was not opposed to doing a little experimentation with my metroprolol (seeing as it was not a major, life altering drug). I suspected it was causing me to feel sluggish, but didn't know for sure. So I weaned myself off of it and recorded how I felt. Then I weaned myself back up to the dose I was on and measured the noticable change. When I was off of it, I took pulse and BP measurements and was able to show the doc that the meds weren't doing me any favor - my BP and pulse were well within normal limits w/out it, and were dropping into sluggish zone with it (pulse in the 50's, BP 90/60). Armed with that data, he was happy to agree with my conclusion that I should go off of it.

The above is just a long way of saying that your doctor needs information to make a change. If you feel a change is warranted, help your doc out by providing a few data points if you can.

Melissa

[William]

I've been on Ace Inhibitors for 2 years plus. I can't say I notice any side effects, other than a bit of light headedness when the dose has to be increased. What are some of the side effects you felt with the Beta Blockers? Will

[Phyllis]

Dick had cut his Lopressor dose in half to 25mg/twice a day and we took daily pressure and pulse readings for two weeks. It averaged 136/72 with a pulse rate of 74. (about the same as on the original dose) Faxed the readings to the cardio to see if he wanted Dick to continue on the reduced dosage, go back to the old dosage, replace the Lopressor with a blood pressure med. or add a blood pressure med to the Lopressor. We also asked if he agreed that the beta blocker may lessen the load on the heart and increase the longevity of the valve for those who are athletic and place more demand on the heart for shorter periods of time. Just got a call from his nurse (I hate that as it leaves no opportunity to question the doctor) and she said that he wants him to remain on the Lopressor at the reduced dosage. No comment as to the beta blocker reducing the load on the heart. He really has no side effects from the Lopressor, so we will follow the cardio's advice, but I still wonder if it's keeping the blood pressure low enough.

[PJmomrunner]

I was told by my cardiologist that the chief benefit of the beta blocker is its effect on the rate at which the blood pressure rises. This rate change is measured in very small time increments (milliseconds? nanoseconds? I don't remember the unit). My understanding was that this is desirable because it eliminates forceful surges in blood pressure--there can still be surges, there is just no "zero to 60 in no time" effect. For me, with an aneurysm, the forceful surges are most dangerous to my fragile aorta. It would stand to reason that those forceful surges would cause the most wear and tear on valves as well as arteries, I would think.

Like Phyliss is wondering about Dick, I am wondering if my BP is low enough--I think it could be lower. This thread has caused me to plug my last 60 BP readings into a spreadsheet and give my own results some thought. I had a dosage increase in my Toprol XL about a month ago so that I am now taking 50mg twice a day. There has been no significant change (118/77 vs. 118/76) in average BP and only a 3bpm change in heart rate (59bpm to 56bpm).

[tobagotwo]

Atenolol is a beta blocker, but it has one difference: it does not pass the blood-brain barrier like the other beta blockers do, and is thus credited with fewer performance side effects. There are quite a few of us here on it. It's another option to bring to the table.

Best wishes,

[TomS]

I've been speaking with some friends and all agree that there is nothing "in it for a doctor" to ever take you off of a medication like a beta blocker. There is only a downside if they do so and anything god forbid happens. Once they put you on a medication, assuming there are no major side effects, they typically just won't take you off of it. The consensus opinion that I'm hearing is that it's even worse if another doctor put you on the medication. Now your cardiologist will have to make a decision against another doctors decision. What do you think? Are we crazy seeing this in this light? Can someone tell me that I'm wrong? I have a cardiologist that is seemingly afraid of his own shadow (and am currently looking to replace him). Everything is a "potential big problem" to him, and he's clearly afraid to give out any advice without a caveat about what "could possibly happen" no matter what I want to do - including sneeze.

[Phyllis]

It's an interesting point, Tom. Dick was originally put on the beta blocker by his surgeon at Brigham. Since we are using a local cardiologist in CT for continued care, I have often had the feeling that he is loath to change any instructions originally given by the Brigham doctors. He was originally on a statin because Dr. Cohn at Brigham felt it would help the new valve from calcifying. When Dick's cholesterol numbers (which were never high) went extrememly low, the local cardiologist suggested we cut the dose in half. When we cut it out completely on our own, he went along with it saying his group did not feel that it had been proven that a statin helped a new valve from calcifying. Now, he finds no reason to switch from the beta blocker to a blood pressure medication. We also checked with Dick's VA doctor (who is also a cardiologist) for a second opinion re the beta blocker and he said, "A beta blocker is also a good pressure regulator and it's working so why not stay on it."